Healthcare Provider Details

I. General information

NPI: 1912159344
Provider Name (Legal Business Name): FRESNO COUNTY BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 E KINGS CANYON RD
FRESNO CA
93702-3604
US

IV. Provider business mailing address

3533 N PLEASANT AVE APT. H
FRESNO CA
93705-3037
US

V. Phone/Fax

Practice location:
  • Phone: 559-453-4260
  • Fax:
Mailing address:
  • Phone: 559-776-8652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. GWENDOLYN YVETTE MAGEE
Title or Position: MENTAL HEALTH WORKER
Credential:
Phone: 559-776-8652